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Lecture 8.3 rad240 pathology

Lecture 8.3 rad240 pathology. Gastrointestinal pathology Dr shai’. GASTRITIS. ACUTE CHRONIC AUTOIMMUNE OTHER EOSINOPHILIC ALLERGIC LYMPHOCYTIC GRANULOMATOUS GVH. GASTRITIS. ACUTE , HEMORRHAGIC (NSAIDs), particularly aspirin Excessive alcohol consumption Heavy smoking CHEMO

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Lecture 8.3 rad240 pathology

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  1. Lecture 8.3rad240 pathology Gastrointestinal pathology Dr shai’

  2. GASTRITIS • ACUTE • CHRONIC • AUTOIMMUNE • OTHER • EOSINOPHILIC • ALLERGIC • LYMPHOCYTIC • GRANULOMATOUS • GVH

  3. GASTRITIS • ACUTE, HEMORRHAGIC • (NSAIDs), particularly aspirin • Excessive alcohol consumption • Heavy smoking • CHEMO • Uremia • Salmonella, CMV • Severe stress (e.g., trauma, burns, surgery) • Ischemia and shock • Suicidal attempts, as with acids and alkali • Gastric irradiation or freezing • Mechanical (e.g., nasogastric intubation) • Distal gastrectomy

  4. GASTRITIS • ACUTE, HEMORRHAGIC • HISTOLOGY: Erosion, Haemorrage, NEUTROPHILS

  5. GASTRITIS • CHRONIC, NO EROSIONS, NO HEMORRHAGE • Chronic infection by H. pylori • Immunologic (autoimmune), e.g., PA • Toxic, as with alcohol and cigarette smoking • Postsurgical, reflux of bile • Motor and mechanical, including obstruction, bezoars (luminal concretions), and gastric atony • Radiation • Granulomatous conditions (e.g., Crohn disease) • GVH, uremia

  6. GASTRITIS • CHRONIC, NO EROSIONS, NO HEMORRHAGE • Perhaps some neutrophils • Lymphocytes, lymphoid follicles • REGENERATIVE CHANGES • METAPLASIA, intestinal • ATROPHY, mucosal hypoplasia, “thinning” • DYS-PLASIA

  7. GASTRITIS • AUTOIMMUNE (10%) • ANTIBODIES AGAINST • acid producing enzyme H+ • K+ -ATPase • gastrin receptor • and intrinsic factor • OTHER • EOSINOPHILIC, middle aged women • ALLERGIC, children (also eosinophils) • LYMPHOCYTIC, T-Cells, body, DIFFUSE • GRANULOMATOUS, Crohn’s, other granulomas • GVH, in bone marrow transplants

  8. “PEPTIC” ULCERS • “PEPTIC” implies acid cause/aggravation • ULCER vs. EROSION (muscularis mucosa intact) • MUCSUBMUCMUSCULARISSEROSA • Chronic, solitary (usually), adults • 80% caused by H. pylori • 100% caused by H. pylori in duodenum • NSAIDS “STRESS”

  9. Helicobacter pylori • Causes 80% of gastric peptic ulcers • Causes 100% of duodenal peptic ulcers • Causes chronic gastritis • Causes gastric carcinomas • Causes MALT lymphomas

  10. “PEPTIC” ULCERS • Gnawing, burning, aching pain, epigastric • Fe deficiency anemia • Acute hemorrhage • Penetration, perforation: • Pain in BACK • Pain in CHEST • Pain in LUQ • NOT felt to develop into malignancy

  11. “PEPTIC” ULCERS • Bleeding • Occurs in 15% to 20% of patients • Most frequent complication • May be life-threatening • Accounts for 25% of ulcer deaths • May be the first indication of an ulcer • Perforation • Occurs in about 5% of patients • Accounts for two thirds of ulcer deaths • Rarely, is the first indication of an ulcer • Obstruction from edema or scarring • Occurs in about 2% of patients • Most often due to pyloric channel ulcers • May also occur with duodenal ulcers • Causes incapacitating, crampy abdominal pain • Rarely, may lead to total obstruction with intractable vomiting

  12. “ACUTE” ULCERS • NSAIDS • “STRESS” ULCERS • ENDOGENOUS STEROIDS • SHOCK • BURNS • MASSIVE TRAUMA • Intracranial trauma, Intracranial surgery • SEPSIS • EXOGENOUS STEROIDS • CUSHING ULCER

  13. “ACUTE” ULCERS • Usually small (<1cm), superficial, MULTIPLE

  14. GASTRIC DILATATION • PYLORIC STENOSIS • PERITONITIS ( pyloric stenosis) • 1.5-3.0 liters NORMAL • 10 liters can be present • ACUTE RUPTURE is associated with a HIGH immediate mortality rate

  15. “HYPERTROPHIC”* GASTROPATHY RUGAL PROMINENCE (cerebriform) NO INFLAMMATION HYPERPLASIA of MUCOSA

  16. “HYPERTROPHIC” GASTROPATHY • Inaccurate name “hypertrophic gastritis” • Ménétrier disease, resulting from profound hyperplasia of the surface mucous cells with accompanying glandular atrophy, ass. w. CMV, H. Pylori, ↑TGF-α • Hypertrophic-hypersecretory gastropathy, associated with hyperplasia of the parietal and chief cells within gastric glands (normal gastrin) • Gastric gland hyperplasia secondary to excessive gastrin secretion, in the setting of a gastrinoma (Zollinger-Ellison syndrome)

  17. GASTRIC “VARICES” • SAME SETTING AND ETIOLOGY AS ESOPHAGEAL VARICES, i.e., PORTAL HYPERTENSION • NOT AS COMMON AS ESOPHAGEAL VARICES • MAY LOOK LIKE PROMINENT RUGAE • IF A PATIENT HAS GASTRIC VARICES, HE ALSO PROBABLY HAS ESOPHAGEAL, (but probably not vice versa)

  18. GASTRIC TUMORS • BENIGN: • “POLYPS*” (HYPERPLASTIC vs. ADENOMATOUS) • LEIOMYOMAS (Same gross and micro as smooth muscle) • LIPOMAS (Same gross and micro as adipose tissue) • MALIGNANT • (ADENO)-Carcinoma • LYMPHOMA • POTENTIALLY MALIGNANT • G.I.S.T. (Gastro-Intestinal “Stromal” Tumor) • CARCINOID (NEUROENDOCRINE)

  19. BENIGN TUMORS MUCOSA (POLYPS) ---HYPERPLASTIC ---Fundic ---Peutz-Jaeger ---Juvenile ---ADENOMATOUS MUSCLE FAT BEBNIBGNB

  20. MALIG. TUMORS MUCOSA LYMPHS (MUSCLE) (FAT) BEBNIBGNB

  21. WHO GASTRIC NEOPLASMS • Epithelial Tumors: Adenomatous polyps, Adenocarcinoma (papillary, tubular, mucinous, signet ring, adenosquamous, unclassified), Small cell, Carcinoid (neuroendocrine) • Nonepithelial Tumors: Leiomyo(sarc)oma, Schwannoma, GIST, Granular Cell Tumor, Kaposi sarcoma • Malignant Lymphomas:

  22. ADENOCARCINOMA • H. pylori associated, MASSIVELY!!! • Japan, Chile, Costa Rica, Colombia, China, Portugal, Russia, and Bulgaria • M>>F • Socioeconomically related*

  23. SMALL/LARGE INTESTINE • NORMAL: Anat., Vasc., Mucosa, Endocr., Immune, Neuromuscular. • PATHOLOGY: • CONGENITAL • ENTEROCOLITIS: DIARRHEA, INFECTIOUS, OTHER • MALABSORPTION: INTRALUMINAL, CELL SURFACE, INTRACELL. • (I)IBD: CROHN DISEASE and ULCERATIVE COLITIS • VASCULAR: ISCHEMIC, ANGIODYSPLASIA, HEMORRHAGIC • DIVERTICULOSIS/-ITIS • OBSTRUCTION: MECHANICAL, PARALYTIC (ILEUS) (PSEUDO) • TUMORS: BENIGN, MALIGNANT, EPITHELIAL, STROMAL

  24. ANATOMY • SI = 6 meters (100% intraP, except for duodenum), LI = 1.5 meters (50% retroP) • Mucosa, submucosa, muscularis, serosa/adv. 2πr x L = ?

  25. BLOOD SUPPLY • SI: SMA Jejunal, Ileal • LI: SMA, IMA Ileocolic, R, M, L, colic, Sup. Rect • RECTUM: Superior, Middle, Inferior • SMA has anastomoses with CELIAC (pancreatoduodenal), IMA (marginal)

  26. MUCOSA • SI: ABSORPTIVE, MUCUS, PANETH (apical granules) • VILLI • LI: MUCUS, ABSORPTIVE, ENTEROENDOCRINE (basal granules) • CRYPTS (like stomach), NOT villi

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